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Paperwork Reduction Act Notice
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<br />Public rEporting burdev- for this collection of information is estimated to vary from a range of 10 hours as an
<br />aygra~e per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />t a weigYted average for major and minor facilities of 18 hours per response, including time for reviewing
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<br />rpcttbns, searching existing dais sources, gathering and maintaining the data needed, and completing and
<br />awing the collection of information. Send comments regarding the burden estimate or any other aspect of
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<br />Ikctiotr.pf information, including suggestions (or reducing this burden, to Chief, Information.Fglicy
<br />b, PM~33, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />e of Info±mation and Regulatory Affairs, Office of Management and $udget, Washington, DC 20503.
<br />General -Instructions
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<br />1 ,gf form has been partially completed
<br />f. already preprinted.
<br />by preprinting, disregard instructions directed at entry of that information
<br />'Permitree Name/Mailing Address (and facility name/lotxtion, if different)," "Permit Number," and
<br />urge Number" where indicated. (A separate form is required for each discharge.) '
<br />3.iE+ttt:i dates beginning and ending 'Monitoring Period" covered by form where indicated.
<br />~`4~ ~n[er each "Parameter" az specified in monitoring requirements of permit.
<br />utter "Sample Mensuremenr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for torch parameter obtained during "Monitoring Period"; "Marinrum" and "Minimum" are normally extreme high
<br />and low measurements obtained during "Monitoring Period." (Note to mutticipals with secondary treatment
<br />requiremenl~ Enter 30day average of sample measurements under "Average," and enter maximum 7-0ay average
<br />of sample measurements obtained during monitoring fig, find under "Maximum.') ,
<br />Enter "Permit Requirement" for each parante[er under_'72uanriry" and "Quality" az specified in permit.
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<br />~Undei "No Es" enter number of sample measuements during monitoring period that exceed maximum (and/or
<br />.minimum or 7-day average az appropriate) permit requirement for each parameter. If none, enter "0".
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<br />ojAnalysis" bath az ".San+ple Mee~~s~ment" (actual frequency of sampling and analysis used
<br />period) and az "Penr+i! ReguiremArt specified in permit. (e.g., Enter "Coot,." for continuous
<br />or one day per week, "//30" for one~j per month, "//90" for one day per quarter, etc.)
<br />;Enter "Sample Type" both az "Sample Measurement' ~3ctttal sample type used during monitoring period) and az
<br />~"Pergrit Requirement," (e.g., Enter "Grab" for ind~al sample, ':aHC' Cor 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />}Where violations of permit requirements are reported,"aNach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
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<br />'7f "no discharge" occurs during monitoring period, enter""No Discharge" across form in place of data entry.
<br />inter "Name/title ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bot[ont of form.
<br />Mail signed Report to O[tce(s) by date(s) specified in pemtit. Retain copy for your records.
<br />More detailed instructions for use of this Discharge Monitoring Report (Dti1R) form may be obtained from OBice(s)
<br />specJed in permit.
<br />Legal Notice
<br />sport is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />lafion, or by imprisonment for not more than one year, or by both.
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